Identification Level of Awareness and Knowledge of Emirati Men about HPV

One of the most frequent cancers that affects males globally is cervical cancer (CC) that kills hundreds or even thousands of women each year, particularly in underdeveloped nations. The study focuses on human papillomavirus (HPV) that contributes to cervical cancer (CC) development. In the majority of Arab nations, there seems to be no public education or vaccination programs. In research, methodological rigor is employed to find solutions to both theoretical and practical difficulties. This research aims to assess the knowledge and awareness of the HPV vaccination among Emirati men. Results of the research showed that Emirati males had a poor understanding of HPV and its vaccination. According to the findings of this research, Emirati males lack a basic understanding of HPV, which necessitates the implementation of national HPV education initiatives. We have identified several critical knowledge gaps that can be filled in the future regarding HPV infection and vaccination.


Introduction
e human papillomavirus (HPV) is widespread in the United States, and the majority of sexually active persons will get the virus over their lifetime [1]. Chronic oropharyngeal cancer has been associated with genital and anogenital, including oropharyngeal cancer in both men and women who have had persistent oncogenic infections. Most anal and penile cancers are assumed to be caused by HPV (90 percent), which accounts for 70% of vulvar and 60% of penile cancers, according to current estimates. Oropharyngeal carcinoma is expected to surpass cervical cancer in incidence by 2020, making it one of the top 10 most prevalent malignancies in the world [2][3][4]. e U.S. Food and Drug Administration has authorized and licensed three HPV vaccinations for use as preventative measures. According to current recommendations, the most undervaccinated group is males; nevertheless, a two-dose regimen is currently suggested; yet, vaccination coverage across all eligible categories is still low, with males constituting the most undervaccinated segment of the population. 39.7 percent of females and 21.6 percent of males aged 13 to 17 got all doses inside the series in 2014. As a reference, vaccination rates for females have been shown to range from 60.5% to 91.5% in a number of nations [2,5,6].
Research in public health indicates that adoption and uptake of the vaccination are dependent on public awareness and understanding about HPV. A recent study indicated that only 68% of participants from a representative sample of UAE individuals were aware of HPV and the HPV vaccination [5,7,8].
Contrary to popular belief, the bulk of current HPV insight and perception research focuses only on cervical cancer in both men and women. Most people have no idea of the link among HPV and noncervical malignancies, according to studies looking into people's understanding of noncervical HPV-related health consequences.
ere may be substantial consequences for vaccination uptake if more research looks into knowledge and awareness about noncervical HPV-related malignancies, both on its own and in connection to other forms of HPV awareness and knowledge [8].
ere are several ways to improve vaccination rates for all children, such as better understanding parents' knowledge and awareness of noncervical HPV-associated malignancies. Awareness of HPV-associated malignant tumors in humans and the higher risk for anal cancers in men who have intercourse with males may assist men and the parents of boys. e results may be used to build customised educational programs that incorporate information regarding noncervical HPV-associated cancer risks that are most relevant to the intended population. Additional data is needed to support systems-level initiatives that minimize structural obstacles to immunization, screening, and treatment based on results [8][9][10].
11-12-year-olds are now advised to get the HPV vaccine as a preventative measure, with an option for catch-up vaccinations until the age of 26. is was the recommended upper age limit for HPV immunization until recently. For persons aged 27-45, the FDA authorized HPV immunization in 2018 because of the vaccine's safety and effectiveness. According to an advisory committee in June 2019, the HPV vaccination may be given to persons aged 27 to 45 years. is advice is based not just on safety and effectiveness, but rather on vaccination effectiveness and cost-efficiency [11,12].
In the United States, a large percentage of adults are still unvaccinated for HPV, putting them at risk of developing malignancies linked to HPV because of the country's persistently low HPV vaccination rates among the country's most important cohort, teenagers, and among catch-up young adults. 15.8 percent of females and 3.2 percent of males between the ages of 27 and 45 have gotten at least one dose of the HPV vaccination, according to the National Health Interview Survey 2017 [13]. According to these recommendations, it may not be necessary to vaccinate everyone in this age group, but rather to have a discussion with their healthcare provider about the possibility of vaccination. A better assessment of adult knowledge and awareness of HPV vaccination might help guide future interventions for this group [14].
e Health Information Nationwide Trends Survey (HINTS), sponsored by the National Cancer Institute (NCI), collects data on how the public uses cancer-related information on a national level. An adult sample in the US has been surveyed using this data source in the past to determine their knowledge and understanding of HPV. Researchers have utilized HINTS to examine discrepancies in HPV understanding and information across racial and gender groups, as well as between men and women and throughout the country. According to previous research based on this dataset, males and non-Hispanic black or Hispanic individuals were equally likely to know about HPV and the HPV vaccination, whereas women were much more likely [15]. A 54-year-old woman in this study's sample was found to have a low knowledge of HPV. Men were shown to be less knowledgeable of HPV and the HPV vaccination, as well as of the fact that HPV promotes penile, oral, and anal malignancies, in two further investigations. Even while these studies included adults, they did not particularly target those between the ages of 27 and 45, nor did they include covariates such as the frequency with which individuals sought out cancer-related health information or their insurance status. HPV awareness among males aged 27-45 was shown to be lower than among women, although other HPV-related factors were not explored in this study. To better understand how individuals in this age range, who may now be eligible for HPV vaccines as a result of the updated HPV vaccination recommendations, perceive and learn about HPV and HPV vaccines, a wide variety of sociodemographic, healthcare, and cancer-related aspects must be examined [16].
Middle Eastern civilizations and religious conservatism may be seen across the region from Morocco to Saudi Arabia. As a result, this suggests more restrictive sexual practices than those seen in other civilizations [17]. e frequency of sexually transmitted diseases in this area has previously been claimed to be lower than in the rest of the globe because of this cultural background. Sexual behaviors are becoming more permissive as a result of the fast changes in lifestyle brought about by globalization, particularly among younger generations. Sexually transmitted disease rates might be significantly affected by these changes, even in this location [18].
Cervical cancer rates in this area are thought to be lower than those in the rest of the globe, despite the lack of cancer registries. One reason for the change in introducing countrywide cervical cancer prevention initiatives in this region is that despite erroneous incidence numbers, breast cancer was diagnosed as the most frequent disease in women in Algeria and Morocco and the third most prevalent cancer in Tunisia, Qatar, and the United Arab Emirates [19]. ere is still a high incidence of cervical cancer in the Arab nations, despite the low prevalence. e launch of a safe and efficient anti-HPV vaccination in the Arab MENA region and the rest of the globe is a fantastic chance to eliminate cervical cancer as well as many other HPV-related illnesses in the region and throughout the world. HPV vaccination was authorized in June 2006 by that of the Food and Drug Administration for primary prevention of the disease. Cervarix, a bivalent HPV vaccination, and Gardasil, a quadrivalent HPV vaccine, are now on the market [20]. It is safe to say that both vaccinations have high effectiveness profiles in reducing HPV infection. Vaccination against HPV is becoming more popular around the world, and it has been approved in more than 150 jurisdictions. As a result, HPV vaccination programs are very unusual in Arab countries, with only one country having successfully implemented the vaccine via a national program, but very few others planning to do so in the foreseeable future [13]. Anti-HPV immunization in the area has been slowed by a number of problems, including budgetary restrictions, a lack of infrastructure for delivering vaccinations to adolescents, and competition from other high-priority vaccines [21]. A major barrier to widespread use of the anti-HPV vaccination is a lack of political will, which is sometimes explained by cultural or religious concerns. is might restrict the reach of such vaccination campaigns and their effectiveness. e vaccination was well-tolerated in the United Arab Emirates during its first year of use, according to the country's experience. As a result of an erroneous media campaign stoking fear about the vaccine's putative side effects, this number dropped to 59% in 2010/2011 [22].
e study contribution finds out whether or not a representative sample of Emirati males was aware of and knowledgeable about HPV. HPV vaccination, awareness and understanding of HPV-associated cervical cancer, knowledge and awareness of noncervical or "other" HPV-associated malignancies, and general HPV awareness and knowledge were all examined in the research. e influence of sociodemographic factors on research and understanding was also examined [22,23].

Aim of Research.
is study aims at identifying the level of awareness and knowledge of Emirati men about HPV, where they got that information, and what exactly they know about HPV.

Methodology
Consider research as a broad phrase that incorporates a diverse array of activities. Methodological rigor is used in research to find answers to both theoretical and practical problems.
ere are a range of approaches available depending on the goal and context of the study, including the following: descriptive analysis, which focuses on amassing data that establishes the existence of a phenomenon. For instance, applied analysis in product design, design engineering, and policy formulation aims to answer practical questions but also aid decision-making; in theoretical research, on the other hand, research is conducted to pique scientific curiosity rather than to immediately apply findings in real-world applications. For the study topic, qualitative research (e) studies aspects that cannot be quantified and hence cannot be susceptible to estimate and quantitative interpretation. In contrast, quantitative research (f ) necessitates extensive use of tools and methodologies [24].

Study Approach and Strategies.
To gather the main data, a quantitative cross-sectional survey was carried out. Quantitative analysis of the primary data was carried out all over the UAE, and with extreme difficulty, we were able to approach men in this study. A total of 389 survey respondents were surveyed, making for a total sample size of 390.
Information was gathered via the use of questionnaire surveys.

Data Analysis.
e acquired data was tested, analyzed, and interpreted using IBM SPSS. As a consequence, a descriptive study was used to properly interpret the findings. In qualitative research, the term "interpretivism" is often used by scholars.
is study employs a descriptive research strategy. Describing new facts about individuals, events, or behaviors through descriptive analysis is a common method of doing so. e findings and features of any study may be described using descriptive analysis, often known as descriptive research [25].

Population.
e research population or participants in our study are Emirati men.

Materials/Instruments.
is quantitative research was conducted using the primary data. Data were gathered from 389 survey respondents in a sample size of 390, and a questionnaire survey was employed to acquire the data.

Results
e present section of the study explains the results of the survey. Looking at Table 1, it can be seen that the total number of samples is 389, upon which the study objectives are relied. e assessment of the respondents' views on the HPV regarding whether they have ever heard about HPV shows 65% agreement response while the remaining 324 respondents provided a negative response. Table 2 shows the frequency distribution of the respondents over where they got the information about the HPV, indicating that the Internet is the most viable tool from which respondents get their information. Other than the Internet, it can be seen that advertisement, books, brochure, college, hospitals, and digital media such as twitter can also be effective tools to impart the knowledge about the HPV. e highest frequency can be seen from the online/Internet tools.
In order to assess the opinion of the respondents about the HPV infection, the frequency analysis shows the highest percentage (83.1%) for not applicable, while sexually transmitted disease as indicated in Table 3 shows a percentage of 10.8%. 0.5% of people gave their opinion on airborne infection, while 1.3% of the respondents' opinion was blood infection.
As shown in Table 4, assessment of the source of infection shows that only 0.3% of people think that disease is sexually transmitted or otherwise transmitted through blood and genetics, while 0.3% of people responded to be infected through wound.
As shown in Table 5, relationship between HPV and other types of cancers shows a 13.3% agreement response and only 1.3% disagreement response.
As shown in Table 6, assessment of whether HPV causes oral cancer shows an 0.8% agreement response and 5.6% disagreement response while 6.7% of people do not know at all, and only 3.3% of respondents gave no response.
As shown in Table 7, assessment of the respondents on whether HPV causes pharyngeal cancer shows only 1% agreement response and 5.6% disagreement response. 6.2% of the respondents do not know at all, while 3.3% of the respondents did not respond at all.
As shown in Table 8, assessment of whether HPV causes tonsillar cancer shows only 0.8% agreement response while 5.6% of the respondents provide disagreement response. Only 6.2% of the respondents did not respond at all, while 83.6% responded with not applicable.
As shown in Table 9, the assessment of whether HPV causes penile cancer shows 4.1% agreement response and 2.3% disagreement response. 6.2% of people do not know while 3.6% did not respond. 83.6% of the responses are not applicable.
As shown in Table 10, the assessment of whether HPV causes perianal cancer shows 3.1% agreement response and 3.3% disagreement response. 6.2% of the respondents do not know, while 3.6% of the respondents did not respond at all out of 389.
As shown in Table 11, the assessment of the respondents' information on the prevention of the HPV cancer shows a 32.3% agreement response while 9.5% of the respondents show that it cannot be prevented. 50% of the population does not know at all, while 7.9% of the population did not respond at all.
As shown in Table 12, the assessment of whether antibiotics prevent HPV shows that only 3.1% of the respondents provided an agreement response, while 21.3% of the respondents provided a negative response. 1% of the people do not respond, while 6.9% of the people do not know.
As shown in Table 13, the assessment of whether HPV can be prevented through pap smear shows that only 3.6% of the people agreed while 20.8% of the respondents did not agree on the statement.
As shown in Table 14, on evaluating whether HPV can be prevented through regular ultrasound, only 2.8% of the respondents agreed, while 21.5% of the people responded no. 6.9% of the respondents do not know it, while 1% of the population does not respond at all. It can be said that HPV cannot be prevented through regular ultrasound as per reflected through the respondents of the study.
As shown in Table 15, on assessing whether HPV can be prevented by vaccination, 17.2% of the respondents agreed, while 7.2% of the respondents did not agree and gave a negative response. 1% of the population do not respond while 6.9% of the population do not know about it. It can be established from the survey analysis that HPV can be prevented by the vaccination but the vaccine should be taken before the contact of the virus.

Discussions
ere is a wide range of variation in the general public's understanding of HPV. Gender, age, education, marital status, wealth, and race were all shown to be linked with previous authors' estimates of general HPV awareness when looking at sociodemographic variables [26]. It is important to note that gaps in HPV knowledge and awareness persist, especially given the persisting differences in vaccine uptake, overall undervaccination of susceptible groups in the UAE males, and higher observed prevalence of various HPVrelated malignancies among men [27,28].
All participants had a good understanding of HPV's relationship with cervical cancer, but they had little idea of the link between HPV and other malignancies. Noncervical malignancies' relationship with HPV has not been the subject of comprehensive inquiry or reporting in the research literature to this point. e results reported by the few research that have been published are consistent [29,30].
Previous studies have consistently indicated that women had higher levels of vaccination understanding and information than men. e results on vaccine understanding and information and gender are at conflict with this. It was shown that being a woman was a significant and favorable predictor of actual vaccine knowledge, but that was only true for males who claimed to have heard of the immunization. Analytical approaches and knowledge categories may be to blame for these differences, according to our hypothesis. Men may have heard about HPV vaccination, but when other sociodemographic criteria are taken into account, it has little influence on real knowledge of HPV vaccine [31].
Considering the importance of vaccine effectiveness, it was surprising to discover that the majority of the respondents did not think the vaccination prevented cervical cancer. Despite no significant differences in the percentage of men and women reporting talking to someone like a doctor about vaccination, women were far more likely than men to have received a doctor's advice to vaccinate. Vaccination recommendations are more likely to be given to female patients and parents of female children, according to previous studies. A combination of sexism and the fact that the vaccination has only been approved for boys since 2011 may explain the present results [32,33].

Implications for Practice.
Health education researchers and practitioners may benefit from this study's results, which are summarized below. First and foremost, there was a lack of understanding and awareness of many elements of HPV, despite continued attempts to do so. Many intervention studies have shown the beneficial impact of receiving information on people's willingness and ability to become vaccinated. Informational interventions alone may not be adequate for long-term increases in vaccination uptake rates, according to a new comprehensive evaluation     Journal of Healthcare Engineering of the evidence. Our findings indicate that more HPV education efforts are required. Priority should be given to evaluating the efficacy of educational interventions on their own and in conjunction with other approaches [34,35].
Another problem was the lack of public awareness and knowledge about the relationship between HPV and other types of HPV-related malignancies. is discovery is especially significant in light of studies indicating that vaccination decision-making might be influenced by personal significance. Individuals and parents are more likely to accept and plan to vaccinate when they have a greater estimation of their own HPV risk and a higher estimation of the vaccine's advantages. When HPV-related health effects particular to males, such as disproportionate incidence of oropharyngeal cancer and penile cancer, are highlighted, men are more likely to support vaccination uptake. Men and parents of boys may benefit from educational activities that stress the danger of noncervical HPV-associated cancers, according to these data [36].
Noncervical HPV-associated cancer awareness and knowledge are also important for methodological reasons.
ere has been a lack of emphasis paid to HPV's relationship    Journal of Healthcare Engineering with noncervical HPV-associated malignancies in the current literature. Increased precision in measurement will add to the already existing corpus of information. Noncervical cancer awareness and knowledge may be assessed by including questions on awareness and knowledge [37,38]. Last but not least, a lack of vaccination awareness and a widespread misconception that the vaccine is ineffective in preventing cervical cancer point to the need of public education on the subject. Interactions between healthcare providers and their patients give an opportunity to dispel common misunderstandings regarding risk, effectiveness, and other important decision-making variables [19]. Patient-provider communication and strong vaccination recommendations seem to have an impact on vaccine uptake. National Immunization Survey-Teen results show that parents vaccinated their daughters more regularly on the suggestion of their health care professionals than they did their sons, according to the 2013 survey. All patients and their parents should be given clear, unambiguous vaccination recommendations by healthcare practitioners. e usual education and education for healthcare personnel should address gender prejudice. It is possible to increase vaccination rates by implementing systems-level methods, such as policy, that make vaccination recommendations routine [19,37,39,40].    Interesting about our results is the significant desire to learn more about the vaccination and the readiness to be vaccinated or to have their daughters vaccinated, despite the dearth of understanding about HPV, its causative association with cervical cancer, and the availability of the vaccine.
ese findings point to a major potential for HPV and cervical cancer education and awareness campaigns. ere seems to be a lack of political will for national cervical cancer prevention due to a lack of cultural barriers. On the basis of our results, a vaccination of this kind might be more widely accepted if the general public was made more aware of HPV's importance, danger, and possible problems [39,41]. A cultural barrier was noted only by 18% of the participants in research done in the one country with an existing national program, suggesting that this explanation was not one of the primary impediments [42]. Countries that want to implement a vaccination program and that consider cervical cancer a public health issue might benefit from these findings. Public expectations are met and vaccine acceptance is maximized when education techniques and interventions focused at boosting awareness and information about HPV and the anti-HPV vaccination are implemented, according to our results [41]. Qualitative findings from this analysis revealed that public trust problems including worries about side effects and safety typically play a role in determining acceptance. Health care providers, particularly students, would also need education and training, since this category showed average anti-HPV acceptance [43]. Cervical cancer education would be a top focus for these existing and future doctors because of their critical role in promoting cervical cancer awareness and screening among the general public. e only option for health authorities that can reassure the public and guarantee excellent vaccination acceptance is to provide scientifically accurate information in a constructive way, either particular training for health practitioners or through community outreach [44,45].

Conclusions
Several features have an effect on people's general awareness about HPV, knowledge of HPV-related malignancy, and knowledge of the HPV vaccination. More has to be done to increase HPV vaccination uptake, especially among those populations identified in this research as having poor HPV awareness. Improving our understanding of HPV might be crucial to increasing vaccination rates in the future. at relationship between sociodemographic variables, HPV knowledge, and vaccination uptake has to be explored further via research to be clear. Given the significance of personal relevance in vaccination decision-making, studies that investigate knowledge of noncervical HPV-associated malignancies should be prioritized. Health educators will be better able to influence uptake if they continue to study and record the effectiveness of their intervention tactics. Patient-provider relationships are crucial for vaccination acceptability and should be further studied and practiced in public health.

Data Availability
e data used to support the findings of this study are included within the article.

Conflicts of Interest
e authors declare that they have no conflicts of interest.
Acknowledgments e authors would like to thank the following students of the CMHS for their help with this research, and their endeavor and persistence helped us approach men in a very conservative community with regards to a very sensitive matter